EXPERIENCE IN DELIVERING MEDICAL CARE TO THE WOUNDED UNDER UNDERGROUND DEPLOYMENT CONDITIONS OF AN ADVANCED SURGICAL TEAM

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Yurii PALAMARCHUK

Lieutenant Colonel of the Medical Service

Head of the Surgical Department of the Mobile Surgery Clinic, Military Medical Clinical Center of the Central Region, Candidate of Medical Sciences

Yevhen ANTONIUK

Lieutenant Colonel of the Medical Service

Head of the Mobile Surgery Clinic, Military Medical Clinical Center of the Central Region

Roman KUZIV

Lieutenant Colonel of the Medical Service

Commander of the Military Medical Clinical Center of the Eastern Region

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INTRODUCTION

In the context of real combat operations during the repulsion of the full-scale armed aggression of the Russian Federation against Ukraine, which is accompanied by a large number of wounded and killed, the preservation of the life and health of servicemembers becomes particularly relevant. This is defined by Article 3 of the Constitution of Ukraine, which states that “a human being, their life and health, honor and dignity, inviolability and security are recognized in Ukraine as the highest social value” [1].

Timely provision of medical care is of key importance for saving the lives of wounded servicemembers and achieving positive treatment outcomes. This is ensured through the coordinated work of medical personnel at all stages of medical evacuation [2,3].

Taking into account modern surveillance capabilities, the issues of camouflage, location, and fortification of medical facilities are a vital necessity both for the wounded and for medical personnel. Safe working conditions for military medical personnel significantly improve treatment outcomes for servicemembers.

Demonstrating the feasibility and effectiveness of providing medical care to the wounded, taking into account safety issues for patients and medical personnel, is ensured by the underground location of the medical facility of the forward surgical group.

MATERIALS AND METHODS

Legislative and regulatory acts of the state concerning healthcare and defense, doctrinal and guiding documents, and medical documentation data for each clinical case were used. Research methods included bibliographic, analytical, systems-based, and generalization methods.

RESULTS AND DISCUSSION

Based on the experience of medical support of troops during armed conflicts, the most common causes of preventable death among servicemembers from wounds are hemorrhage (60%), pneumothorax (30%), airway obstruction (5%), and another 5% due to other causes. At the same time, approximately 20–25% of those killed on the battlefield and during the early stages of medical evacuation could have been saved if timely and high-quality tactical prehospital and primary medical care had been provided [4,5].

One example of coordinated work by the medical service at all stages of medical evacuation is the following clinical case. Servicemember K. was delivered by a primary medical care team to the Mobile Surgery Clinic of the Military Medical Clinical Center of the Central Region — a forward surgical group — after a blast injury caused by an FPV drone striking a vehicle. The servicemember was admitted to an underground medical hospital located in close proximity to the line of combat operations 2 hours after sustaining the injury, in an extremely critical condition.

Diagnosis: Blast injury; multiple blind gunshot fragmentation wounds of the face; multiple blind gunshot fragmentation wounds of the left upper limb with a gunshot fracture of the left humerus; multiple blind gunshot fragmentation wounds of the left chest, left-sided hemopneumothorax, injury to the left subclavian artery, foreign body in the wall of the aortic arch; multiple blind gunshot fragmentation wounds of the torso and lower limbs; grade IV hemorrhagic shock.

Surgical treatment was performed: temporary shunting of the left subclavian artery, left-sided thoracocentesis, installation of an external fixation device on the left humerus, and primary surgical debridement of multiple blind gunshot fragmentation wounds of various locations. Intensive anti-shock therapy, transfusion of blood and blood products, and stabilization of vital body functions were carried out.

The wounded servicemember was transported by a resuscitation ambulance to the next stage of medical evacuation — Role 3 — where surgical correction of the injuries was performed: autovenous reconstruction of the left subclavian artery, left-sided thoracotomy, and removal of the foreign body from the wall of the aortic arch. On the second day of the postoperative period, the patient was evacuated in stable condition to the next stage of medical evacuation — Role 4.

CONCLUSIONS

The coordinated work of military medical personnel at all stages of medical evacuation is an extremely important component of the system of treatment and evacuation measures in the Armed Forces of Ukraine. This work is essential for preserving the lives of servicemembers in combat conditions, and the success of their further treatment and rehabilitation, as well as the prospects for returning wounded servicemembers to duty, depends on its timeliness.

The underground location of medical facilities where specialized medical care is provided — Role 2 — makes it possible to provide rapid and high-quality medical care to wounded servicemembers under safer conditions.

The safe location of military medical facilities near the line of combat contact provides additional protection for the life and health not only of wounded servicemembers, but also of medical personnel. The long-term preservation of the integrity of the medical facility itself maintains its functionality and the ability to save as many military lives as possible.

REFERENCES

1. Constitution of Ukraine, adopted at the 5th session of the Verkhovna Rada of Ukraine on 28 June 1996. Vidomosti Verkhovnoi Rady Ukrainy (VVR), 1996, No. 30, Article 141.

2. Order of the Ministry of Defense of Ukraine dated 03 September 2024 No. 598 “On Approval of the Scope of Medical Care at the Prehospital Stage Provided During Combat Operations and the Preparation of Security and Defense Forces for Their Intended Use in Tactical Conditions.” Registered with the Ministry of Justice of Ukraine on 10 September 2024 under No. 1359/42704.

3. Order of the General Staff of the Armed Forces of Ukraine dated 20 December 2017 No. 445 “On Approval of the Doctrine of Medical Support of the Armed Forces of Ukraine.”

4. “Platinum” Minutes of the “Golden” Hour / [Electronic resource] — Available at: http://viysko.com.ua/jornal/platy-novi-hvy-ly-ny-zolotoi-gody-ny/

5. Bilyi V.Ya., Verba A.V., Badiuk M.I., Zhakhovskyi V.O., Livinskyi V.H., Kudrenko M.V., Slabkyi H.O., Melnyk I.P. (2016). The Relevance of the “Platinum Minute” and the “Golden Hour” for the Modern System of Treatment and Evacuation Measures / Ukraine. Nation’s Health — 2016. — No. 4. — pp. 19–27.